Coronary heart disease and the course of newly detected prostate cancer

Introduction. In recent years, the clinical and practical interest in malignant neoplasms and diseases of the cardiovascular system has been extremely high. These nosologies are the leading causes of hospitalisations and deaths worldwide.

Objective. To assess the prevalence of coronary heart disease and risk factors among patients with newly diagnosed prostate cancer, as well as to identify their relationship with the severity of prostate cancer.
Materials & methods. The study included 140 newly diagnosed prostate cancer (PCa) patients with a median age of 65 [62; 70] years. All patients had the level of prostate-specific antigen, pelvic MRI, prostate biopsy with determination of Gleason score, all patients filled out the questionnaire of the International Index of Erectile Function (IIEF-5). Depending on the presence of coronary heart disease (CHD), all patients were divided into two groups: Group 1 — 94 (67%) PCa patients without CHD; Group 2 — 46 (33%) PCa patients with CHD

Results. In a comparative analysis, the groups did not differ in indicators such as age, BMI, prostate volume, incidence of diabetes mellitus type 2, and lipid status level. However, in PCa patients with CHD, erectile dysfunction was statistically significantly more pronounced than in patients without CHD (10 vs 18 IIEF5 points, p = 0.03), respectively. In terms of PSA levels, it turned out that in Group 2, this indicator was significantly higher than in Group 1 (15.8 ng/ml vs 10.1 ng/ml, p = 0.03), respectively, which indicates possibly more high malignancy of the process. Furthermore, in Group 2, patients with a high grade PCa according to the classification of The International Society of Urological Pathology (ISUP) 4 / 5 were statistically significantly more common compared to patients of Group 1 (12 (26%) vs. 10 (11%), p = 0.01), respectively. In a comparative analysis of patients depending on the risk of a possible PCa recurrence of , which was taken into account by such parameters as PSA level, Gleason index + ISUP grade, it turned out that in  Group 2 there were statistically significantly more patients with a higher risk of PCa progression compared to Group 1 (20 (44%) vs 26 (28%), p = 0.02), respectively.

Conclusion. PCa patients with concomitant CHD are characterized by a higher waist circumference, they had lower indicators of erectile function, a more pronounced comorbid background, and more often had a history of stroke. In addition, PCa patients with CHD had a high grade PCa and a higher risk of PCa progression.

1. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: 13.04.2023 https://gco.iarc.fr/today,accessed

2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. Erratum in: CA Cancer J Clin. 2020;70(4):313. DOI: 10.3322/caac.21492

3. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941-1953. DOI: 10.1002/ijc.31937

4. Kaprin A.D., Starinskij V.V., Petrova G.V. Zlokachestvennye novoobrazovanija v Rossii v 2016 godu (zabolevaemost' i smertnost'). Moscow: MNIOI im. P.A. Gercena filial FGBU «NMIC radiologii» Minzdrava Rossii; 2018. (In Russian).

5. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. Erratum in: Circulation. 2020;141(2):e33. DOI: 10.1161/CIR.0000000000000659

6. Davis MK, Rajala JL, Tyldesley S, Pickles T, Virani SA. The Prevalence of Cardiac Risk Factors in Men with Localized Prostate Cancer Undergoing Androgen Deprivation Therapy in British Columbia, Canada. J Oncol. 2015;2015:820403. DOI: 10.1155/2015/820403

7. Epstein MM, Edgren G, Rider JR, Mucci LA, Adami HO. Temporal trends in cause of death among Swedish and US men with prostate cancer. J Natl Cancer Inst. 2012;104(17):1335-42. DOI: 10.1093/jnci/djs299

8. Cereda V, Falbo PT, Manna G, Iannace A, Menghi A, Corona M, Semenova D, Calò L, Carnevale R, Frati G, Lanzetta G. Hormonal prostate cancer therapies and cardiovascular disease: a systematic review. Heart Fail Rev. 2022;27(1):119-134. DOI: 10.1007/s10741-020-09984-2

9. Cuzick J, Thorat MA, Andriole G, Brawley OW, Brown PH, Culig Z, Eeles RA, Ford LG, Hamdy FC, Holmberg L, Ilic D, Key TJ, La Vecchia C, Lilja H, Marberger M, Meyskens FL, Minasian LM, Parker C, Parnes HL, Perner S, Rittenhouse H, Schalken J, Schmid HP, Schmitz-Dräger BJ, Schröder FH, Stenzl A, Tombal B, Wilt TJ, Wolk A. Prevention and early detection of prostate cancer. Lancet Oncol. 2014;15(11):e484-92. DOI: 10.1016/S1470-2045(14)70211-6

10. Рева С.А., Кудинова Н.И., Лапин С.В., Петров С.В. Генетическое исследование как метод оценки предрасположенности к развитию рака предстательной железы. Вестник урологии. 2020;8(3):103-110. Reva S.A., Kudinova N.I., Lapin S.V., Petrov S.B. Genetic research as a method for assessing susceptibility to prostate cancer. Urology Herald. 2020;8(3):103-110. (In Russian). DOI: 10.21886/2308-6424-2020-8-3-103-110

11. Koene RJ, Prizment AE, Blaes A, Konety SH. Shared Risk Factors in Cardiovascular Disease and Cancer. Circulation. 2016;133(11):1104-14. DOI: 10.1161/CIRCULATIONAHA.115.020406

12. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-30. DOI: 10.1016/s0090-4295(97)00238-0

13. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023.

14. Purysko AS, Rosenkrantz AB, Turkbey IB, Macura KJ. RadioGraphics Update: PI-RADS Version 2.1-A Pictorial Update. Radiographics. 2020;40(7):E33-E37. DOI: 10.1148/rg.2020190207

15. Narayan V, Harrison M, Cheng H, Kenfield S, Aggarwal R, Kwon D, McKay R, Hauger R, Hart N, Conzen S, Borno H, Jim H, Dicker A, Dorff T, Moslehi J, Mucci L, Parsons JK, Saad F, Soule H, Morgans A, Ryan CJ. Improving research for prostate cancer survivorship: A statement from the Survivorship Research in Prostate Cancer (SuRECaP) working group. Urol Oncol. 2020;38(3):83-93. DOI: 10.1016/j.urolonc.2019.10.006

16. Leong DP, Fradet V, Shayegan B, Duceppe E, Siemens R, Niazi T, Klotz L, Brown I, Chin J, Lavallee L, Mousavi N, Luke P, Lukka H, Gopaul D, Violette P, Hamilton RJ, Davis MK, Karampatos S, Mian R, Delouya G, Fradet Y, Mukherjee S, Conen D, Chen-Tournoux A, Johnson C, Bessissow A, Dresser G, Hameed AK, Abdel-Qadir H, Sener A, Pal R, Devereaux PJ, Pinthus J. Cardiovascular Risk in Men with Prostate Cancer: Insights from the RADICAL PC Study. J Urol. 2020;203(6):1109-1116. DOI: 10.1097/JU.0000000000000714

17. Holmes JA, Anderson RF, Hoffman LG, Showalter TN, Kasibhatla M, Collins SP, Papagikos MA, Barbosa BD, Alligood K, Stravers LJ, Mahbooba Z, Wang AZ, Chen RC. Cardiovascular Preventive Care and Coordination of Care in Prostate Cancer Survivors: A Multi-Institutional Prospective Study. Int J Radiat Oncol Biol Phys. 2019;103(1):112-115. DOI: 10.1016/j.ijrobp.2018.07.2018

18. Shikanov S, Kocherginsky M, Shalhav AL, Eggener SE. Cause-specific mortality following radical prostatectomy. Prostate Cancer Prostatic Dis. 2012;15(1):106-10. DOI: 10.1038/pcan.2011.55

19. Di Francesco S, Tenaglia R. Vascular Disease and Prostate Cancer: A Conflicting Association. J. Can. Res. Updates. 2014;3(1):81-84. DOI: 10.6000/1929-2279.2014.03.01.9

20. Di Francesco S, Robuffo I, Caruso M, Giambuzzi G, Ferri D, Militello A, Toniato E. Metabolic Alterations, Aggressive Hormone-Naïve Prostate Cancer and Cardiovascular Disease: A Complex Relationship. Medicina (Kaunas). 2019;55(3):62. DOI: 10.3390/medicina55030062